难治性肺炎支原体肺炎患儿肺泡灌洗液细胞学计数及肺炎支原体耐药基因检测的临床意义  

Clinical significance of cytological count and mycoplasma pneumoniae drug resistance gene in bronchoalveolar lavage fluid of refractory mycoplasma pneumoniae pneumonia in children

作　　者：陈微 郏丽娜 管敏昌[2] 杭金国 汤卫红[2] 汪官富[3] 

机构地区：[1]浙江省台州恩泽医疗中心(集团)路桥医院检验科,318050 [2]浙江省台州恩泽医疗中心(集团)路桥医院儿科,318050 [3]浙江省台州恩泽医疗中心(集团)路桥医院科教科,318050 [4]浙江省台州恩泽医疗中心(集团)恩泽医院儿科,318050

出　　处：《中国医药》2017年第3期351-355,共5页China Medicine

基　　金：浙江省医药卫生科技计划（2015KYB446）

摘　　要：目的探讨难治胜肺炎支原体肺炎（RMPP）患儿支气管肺泡灌洗液（BALF）细胞学计数及肺炎支原体（MP）耐药基因检测的临床意义。方法回顾性分析2013年4月至2016年4月台州恩泽医疗中心（集团）下属3个医院（台州医院、中心医院、路桥医院）儿科病房诊断为RMPP的住院患儿45例（RMPP组）及诊断为肺炎支原体肺炎（MPP）的住院患儿45例（MPP组），以同期行支气管镜下异物取出术的患儿45例作为对照组。所有患儿均行支气管肺泡灌洗，检测并比较3组BALF中细胞学计数及MP耐药基因阳性率。结果RMPP组、MPP组和对照组患儿的BALF中有核细胞计数及巨噬细胞、中性粒细胞比例比较，差异均有统计学意义[1．7（0．8，2．6）×10^9／L、1．6（0．7，2．4）×10^9／L比0．8（0．4，1．4）×10^9／L，85．1％（71．5％，91．6％）、86．5％（79．8％，91．5％）比89．1％（81．6％，97．0％），10．5％（4．1％，18．3％）、6．5％（2．O％，14．0％）比2．6％（1．4％，4．1％）]（均P〈0．01）；3组淋巴细胞、嗜酸性粒细胞比例比较，差异均无统计学意义（均P〉0．05）。RMPP组和MPP组的MP耐药基因阳性率均明显高于对照组[80．0％（36／45）、17．8％（8／45）比0．0％（0／45）]，且RMPP组明显高于MPP组，差异均有统计学意义（均P〈0．01）。结论BALF中性粒细胞计数及MP耐药基因检测对儿童RMPP早期识别有一定的参考价值。Objective To explore the clinical significance of cytological count and mycoplasma pneumoniae （MP） drug resistance gene in bronchoalveolar lavage fluid（BALF） in children with refractory mycoplasma pneumoniae pneumonia（RMPP）. Methods A retrospective analysis was performed in pediatric wards of 3 hospitals （Taizhou Hospital, Central Hospital, Luqiao hospital） affiliated to Taizhou Enze Medical Center （Group） in Zhejiang Province from April 2013 to April 2016; 45 children diagnosed of RMPP（ RMPP group） and 45 children diagnosed of mycopiasma pneumoniae pneumonia（ MPP group） were enrolled; 45 children who had bronchoscopy for removal of foreign body were enrolled as control group. All children had bronchoalveolar lavage and cytological count and MP drug resistance gene positive rate in BALF were analyzed. Results Nucleated cell count, macrophage ratio and neutrophil ratio in BALF had significant differences among RMPP group, MPP group and control group[1.7（0.8,2.6） ×10^9/L, 1.6（0.7, 2.4）×10^9/L vs 0.8（0.4, 1.4） ×10^9/L; 85.1% （71.5%, 91.6%）,86.5%（79.8%, 91.5%） vs89.1%（81.6%, 97.0%）; 10.5%（4.1%, 18.3%）, 6.5%（2.0%, 14. 0% ） vs 2. 6% （ 1.4% , 4. 1% ） ] （P 〈0. 01 ） ; lymphocyte ratio and eosinophil ratio had no differences among groups（P 〉0.05）. The positive rate of MP drug resistant gene in RMPP group and MPP group was higher than that in control group[80.0% （36/45）, 17.8% （8/45） vs 0. 0% （0/45） ] ; the positive rate of MP drug resistant gene in RMPP group was higher than that in MPP group; the differences were significant（ P 〈 0.01 ）. Conclusion Neutrophil and MP drug resistance gene detection in BALF have certain reference values for early identification of RMPP in children.

关 键 词：肺炎 支原体 支气管肺泡灌洗液 细胞计数 耐药基因 

分 类 号：R563.1[医药卫生—呼吸系统]